Lightning has been the second
largest storm killer in the U.S. for the last 40 years, exceeded only by
floods. A lightning strike can result in a cardiac arrest (heart stopping)
at the time of the injury, although some victims may appear to have a delayed
death a few days later if they are resuscitated but have suffered irreversible
brain damage.

According to Storm Data, a National Weather Service publication, the U.S.
averages 73 reported lightning fatalities per year. Due to under reporting,
the figures are more realistically about 100 deaths per year. Only about
10% of people who are struck by lightning are killed, leaving 90% with various
degrees of disability.

ODDS OF BECOMING A LIGHTNING VICTIM

U.S. 2000 Census population

280,000,000

Odds of being struck by lightning in a given year
(reported deaths + injuries)

1/700,000

Odds of being struck by lightning in a given year
(estimated total deaths + injuries)

1/240,000

Odds of being struck in your lifetime (Est. 80 years)

1/3000

Odds you will be affected by someone being struck
(Ten people affected for every one struck)

1/300

Who Gets Injured

While about one third of all injuries occur during work, workers
compensation companies are often reluctant to acknowledge the injury or
pay related medical expenses. About another third of injuries occur during
recreational or sports activities. The last third occurs in diverse situation,
including injuries to those inside buildings.

How Do Lightning Injuries Affect People?

While any death
is a blow to a family, eventually the family readjusts and goes on. However,
for those who have a relative who suffers significant disability from lightning,
life changes forever and the dreams of that family and the survivor may
be markedly altered. The family income may be tremendously decreased if
the survivor was one of the breadwinners, or the spouse or another family
member may have to quit work to care for the survivor if the disability
is great enough.

While about
one third of all injuries occur during work, workers compensation companies
are often reluctant to acknowledge the injury or pay their medical expenses.
About another third of injuries occur during recreational or sports activities.
The last third occurs in diverse situation, including injuries to those inside
buildings.Many injuries in each
of these groups can be prevented with proper education, well conceived lightning
protection systems that protect the people as well as the equipment being
used or ‘shelters’ where the survivor may seek safety, and lightning safety
plans for coaches, parents, and referees at sporting events. While lightning
safety and injury prevention is an individual responsibility and decision
for adults, adults are ALWAYS responsible for the children in their care,
particularly if it is an outdoor sports activity such as soccer, t-ball,camping, etc.

Unlike high voltage electrical
injuries where massive internal tissue damage may occur, lightning seldom
causes substantial burns. In fact, most of the burns are caused byother objects (rainwater, sweat, metal coins and necklaces, etc)
being heated up and causing the burn rather than caused by thelightning itself.

Lightning tends
to be a nervous system injury and may affect any or all parts of the nervous
system: the brain, the autonomic nervous system, and the peripheral nervous
system.

When
the brain is affected, the person often has difficulty with short-term memory,
coding new information and accessing old information, multitasking, distractibility,
irritability and personality change. A great quote sums it up perfectly:

"Patients
have difficulty in all areas that require them to analyze more items of information
than they can handle simultaneously. They present (appear) as slow because
it takes longer for smaller than normal chunks of information to be processed.
They present as distractible because they do not have the spare capacity to
monitor irrelevant stimuli at the same time as they are attending to the relevant
stimulus. They present as forgetful because while they are concentrating on
point A, they do not have the processing space to think about point B simultaneously.
They present as inattentive because when the amount of information that they
are given exceeds their capacities, they cannot take it all in."

Early on, survivors
may complain of intense headaches, tinnitus (ringing in the ears), dizziness,
nausea, vomiting and other ‘post-concussion’ types of symptoms.Survivors may also experience difficulty sleeping, sometimes sleeping
excessively acutely after the injury but changing during the next few weeks
to inability to sleep more than two or three hours at a time.A few may develop persistent seizure-like activity several weeks to
months after the injury.Unfortunately,
standard EEG’s do not always pick up injury in the areas that lightning most
often affects leading to a diagnosis of ‘pseudoseizures’.

Personality Changes / Self-Isolation

Many may suffer personality
changes because of frontal lobe damage and become quite irritable and easy
to anger. The person who ‘wakes up’ after the injury often does not have
the ability to express what is wrong with them, may not recognize much of
it or deny it, becomes embarrassed when they cannot carry on a conversation,
work at their previous job, or do the same activities that they used to
handle. As a result, many self-isolate, withdrawing from church, friends,
family and other activities. Friends, family and co-workers who see the
same external person, may not understand why the survivor is so different.
Friends soon stop coming by or asking them to participate in activities.
Families who are not committed to each other break up.

Obviously, depression becomes
a big problem for people who have changed so much and lost so much.Suicide is something that almost all severely injured people have
thought about at one time or another.Occasionally, those who do not have access to medical care or who
do not understand what is happening may self-medicate with alcohol and other
drugs, particularly those who have previously sought solace with these compounds.It is very important that the family
and friends of the survivor maintain supportive contact even though it requires
an adjustment in their relationship with the survivor.An injury such as this is an injury
to the family, not just to the person hit.

Fatigue

Survivors often complain of
easy fatigability, becoming exhausted after only a few hours of work. This
may be because every task that they used to automatically do without thinking
now requires intense concentration to accomplish. Many return to work but
find that they cannot multitask and do all of the activities that are required
at their job.

Medical Testing

There are two kinds of medical
tests:

Anatomic
ones that take a simple picture (x-ray) or measurement (blood count)

Functional
ones that show how something is working (PET, neuropsychological testing,
intelligence testing)

Sometimes function can be ascribed
to the anatomic tests but often it cannot so that it is often fallacious
on the basis of a normal static picture to ascribe normal function.The mental changes that the lightning survivor has are functional
(how the brain works) changes, not anatomic ones so that anatomic tests
such as the CT scan and MRI are usually normal. More functional scans such
as PET and SPECT may show changes but are hard to obtain due to their relative
infrequency in medical centers. To use an analogy:if an electric shock were sent through a computer, the outside case
would probably look ok (similar to a photo or x-rays of the person), the
computer boards on the inside would probably look ok and not be fused nor
melted (CT, MRI for the person), but when you boot up the computer it would
have difficulty accessing files, making calculations, printing, etc. similar
to a person with brain injury who has short term memory problems, difficulty
accessing and coding information, difficulty organizing output,

A functional test of how a person’s
brain is working that is seldom thought of by most non-neurologists is called
neurocognitive or neuropsychological testing.These tests are administered by a qualified
neuropsychologist familiar with the literature in this area, not by a psychiatrist,
and consist of a 6-8 hour battery of pen and paper tests including memory,
IQ, organizational ability, and other ‘how the parts of the brain are working’
kinds of tests.Survivors of
lightning and electrical injury usually have a characteristic pattern of
deficits.This type of testing
is expensive and not necessary for most but can sometimes be helpful when
litigation is involved and there is a doubt about the cause of a person’s
injury.

Delayed Problems

Another common,
often delayed problem for some survivors is pain, also a difficult problem
to quantify and manage and one that does not always present initially in the
full-blown pattern that it may have later. The pain may not only present as
the chronic intense headaches mentioned above but may be in the back (perhaps
from compression and disc injury from the intense muscle contractions which
may throw a person several yards at the time of the injury), or in an extremity.
Many may have nerve entrapment syndromes. A small number may eventually develop
classic RSD. (Reflex Sympathetic Dystrophy, Sympathetically Mediated Pain
Syndrome, causalgia)

Sometimes
the functional tests that are ordered are testing the wrong thing an electromyogram
(EMG) measures only the largest nerve fibers, the motor fibers, which are
seldom affected by lightning injury.Smaller pain-carrying nerve fibers are
not tested by EMG so that a ‘normal EMG’ means little when ordered for someone
with pain.Likewise, the standard
EEG does primarily surface readings of the brain and misses seizure activity
in several deeper regions.EEG’s
may not pick up only 50% of temporal lobe seizures (some personality, organizing
ability) and miss 120% of hypothalamic seizures.4

Lack of libido
and impotence are often reported. Other common and not so common complaints
involve the digestive system, the endocrine (hormonal) system, and the immune
system, some of which are currently being studied. It is not clear if these
are directly due to lightning injury, to medication side effects, or to other
incidental causes unrelated to lightning.

Help Exists - Lightning Strike and Electric Shock Survivors, International,
Support Group

An organization that has been
of tremendous help to survivors, their families, their physicians and other
professionals is Lightning Strike and Electric Shock Survivors, International
(LSESSI), a support group formed in 1989 by a gentleman who was injured
in 1969 who became tired of no one recognizing or knowing what to do for
those with lightning injury. LSESSI has printed materials, offers tremendous
support, networks survivors with others in their area, and provides an annual
meeting where survivors come together for support as well as for lectures
from professionals who work with lightning and electrical survivors and
their families. LSESSI can be reached at 912-346-4708, Lightnin@nternet.net,
http://www.lightning-strike.org/index.html,
or at P.O. Box 1156, Jacksonville, North Carolina 28541-1156.

Four Factors Necessary for Recovery

The four most important factors
in overcoming disability from lightning injury (or from any illness or major
injury for that matter) are:

a.A supportive family/friends network.

b.The person or family becoming their own best
advocate and learning as much as they can about their disability.

c.A physician (regardless of specialty) who is
willing to listen, read, learn and work with the survivor and their family.

d.A sense of humor.

Prevention

Far more important than treating survivors
is preventing lightning injury.

1.Holle RL, Lopez RE, Curran EB:Distributions of Lightning-Caused Casualties and Damages Since 1959
in the United States, 11 Conference on Applied Climatology, American Meteorological
Society, January 1999

6.Life After Shock I, Life After Shock II, collections
of stories of lightning and electric shock survivors and how it has changed
their lives, Lightning Strike and Electric Shock Survivors, Intntl, Morris
Publishing, Nebraska,1996/2000.